Helping clients face the caregiver's dilemma: How do I tend to a sick pet without losing myself?
Mary Gardner, DVM
There is nothing better to Dr. Gardner than a dog with a grey muzzle or skinny old cat! Her professional goal is to increase awareness and medical care for the geriatric veterinary patient and to help make the final life stage to be as peaceful as possible, surrounded with dignity and support for all involved. A University of Florida graduate, she discovered her niche in end of life care and is the co-founder and CTO of Lap of Love, which has more than 130 veterinarians around the country dedicated to veterinary hospice and euthanasia in the home. Dr. Gardner and Lap of Love have been featured in Entrepreneur Magazine, The New York Times, the Associated Press, The Doctors and numerous professional veterinary publications. You can usually find Dr. Gardner wherever the party isor the golf course!
When working with owners of very ill pets, your greatest value may not be in the medical arena. Supporting caregivers through education, communication and these other real-world tips can make this trying time easier for owners, your staff and, of course, the pet.
"I love her, but this is really tough." For years when I prepared for hospice cases, I struggled with the thought, “What more can I tell this owner about their pet?” As a hospice veterinarian, my pet patients are mainly coping with a terminal illness or struggling with geriatric conditions that are impinging on their quality of life. Thankfully, many of my patients are already receiving high-quality care from specialty or primary care veterinarians and are being treated under a good medical protocol. Early on in my seven and a half years as a hospice veterinarian, I realized that my greatest value is not in the medical arena but in discussing with owners how to be a caregiver to their pet and helping them evaluate the pet's quality of life. These conversations are priceless to owners, and I've learned to master these appointments.
When I recently attended the American Geriatrics Society's annual conference, I learned that geriatric physicians consider helping the caregivers an integral part of preserving the patient-family bond. Caregivers face a lot of frustration and depression; they are in desperate need of assistance. I compared this to caregivers of chronically ill pets and can see the similarities-at least in my line of work. The 2017 study I reviewed in my companion article Journal Scan: Studying the caregiver burden of owners with very ill pets proved what I've seen anecdotally in my career.
Emotional budget on empty!
Many families struggle with the emotional toll of caring for their sick pet. It is something we are highly sensitive to within our practice. Educating owners and giving them the tools they need to deal with the struggles is vital to a successful relationship with them. I also have to realize that there comes a time when the owner's emotional budget is empty. At that time, the human-animal bond is broken, and often euthanasia is best for everyone. It's important not to judge a family during this time. What you may be able to handle may not match what your clients are able to handle. I reassure the owners that when they are tapped out emotionally, I will be there for them. With that said, my goal is to avoid an emotional burnout-and that is where education and communication are key! There are bountiful resources available for caregivers in the human medicine world but not in the pet world … yet.
Ways to help pet caregivers
Mastery: Help pet owners learn as much as possible about their pet's disease, the clinical signs their pet will face and ways to manage those signs. On our website, the pages that talk about the disease and tips to manage them are popular with pet parents and our veterinary peers alike! Even during appointments, families will tell our veterinarians that the education section of our website was very helpful for them.
Coping strategies: For pet owners, turning to support groups or even counselors may be appropriate during this time. If there aren't any in your area, look for human caregiver groups. Although not identical, they offer wonderful support and ideas on how to manage caregiver fatigue. Always focus on the wonderful care owners are providing rather than the deterioration of the pet-which is sometimes an unavoidable outcome.
Social support: Let owners know that it's not always possible for them to handle all of the responsibilities of caregiving. Encourage them to reach out to friends, family and illness-specific social media groups. CareCorrals is a private online community where owners can create and invite people to join their pet's corral. It offers a calendar for divvying up duties, as well as storytelling tools and other ways to help caregivers find the support they need.
Respite: In human medical caregiving situations, caregivers garner great benefits when they can rely on respite services that give them time to just relax and take care of themselves. This can be a great opportunity for veterinary technicians to get involved. Home care, overnight sitting, treatments, etc., are just the start of ways our technicians can help caregivers. Or you could create a respite program in your clinic!
If we look at human caregiver studies, findings show that caregiver stress also takes an emotional toll on the medical team caring for the patient.1-4 We could theorize that a similar impact occurs in veterinary medicine. If we work to alleviate the stress that caregivers face, we might also ease the stress that is displaced to our veterinary team. This is good not only for the pet owner and your staff, but also, most importantly, for the pet.
- Koh KB, Kim CH, Park JK. Predominance of anger in depressive disorders compared with anxiety disorders and somatoform disorders. J Clin Psychiatry 2002;63:486-492.
- Frostholm L, Fink P, Christensen KS, et al. The patients' illness perceptions and the use of primary health care. Psychosom Med 2005;67:997-1005.
- Hilbert A, Martin A, Zech T, et al. Patients with medically unexplained symptoms and their significant others: illness attributions and behaviors as predictors of patient functioning over time. J Psychosom Res 2010;68:253-262.
- Brodaty H, Hadzi-Pavlovic D. Psychosocial effects on carers of living with persons with dementia. Aust N Z J Psychiatry 1990;24:351-61.
Dr. Gardner is a co-founder of Lap of Love Veterinary Hospice, a network of veterinarians around the country whose goal is to empower every owner to care for their geriatric pets. She is also co-editor and contributing author of the textbook Treatment and Care of the Geriatric Veterinary Patient.